Enlarged Prostate

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

What is the Prostate Gland? What does it do? How Big is It?

The prostate gland serves a fertility function as it secretes the seminal fluid that helps to nourish and transport the sperm that comes from the testicles. The fluid is then stored in the seminal vesicles. The gland itself surrounds the urethra, which is the tube that carries urine from the bladder out through the tip of the penis (see multimedia file 1). As the prostate grows larger, it may press on the urethra. This narrowing of the urethra can cause some men with prostate enlargement to have trouble with urination. Prostate enlargement may be the most common health problem in men older than 60 years of age.

The prostate is a small organ about the size of a walnut. It lies below the bladder (where urine is stored) and surrounds the urethra (the tube that carries urine from the bladder). The prostate makes a fluid that helps to nourish sperm as part of the semen (ejaculatory fluid).

What Causes BPH?

Researchers don't know exactly what causes benign prostatic hyperplasia. One theory suggests that as men age, they begin to produce fewer hormones called testosterone (a male hormone) and small amounts of estrogen (a female hormone). As the male hormone testosterone levels in the blood decrease, it leaves a higher amount of estrogen in the blood. Thus, BPH in men occurs because of the higher proportion of estrogen within the prostate gland increases activity of substances that promote prostate cell growth.

The other theory on what causes BPH is that as men age, the male hormone dihydrotestosterone (DHT) (which plays a role in the development and growth of the prostate gland), may encourage the cells of the prostate gland to continue to grow.

What Are the Signs and Symptoms of BPH?

How Common is BPH? At What Age Does the Prostate Gland Begin to Enlarge?

A man's prostate gland usually starts to enlarge after he reaches 40 years and evolves slowly. It only causes symptoms until over age 50.

What is the Treatment for BPH? Can it be Cured?

Usually, treatment for BPH is reserved for men who have significant symptoms of and enlarged prostate. Medications and surgery treat BPH and its' symptoms.

What Does an Enlarged Prostate (BPH) Look Like (Pictures)?

Male urinary system and prostate: The prostate makes some of the milky fluid (semen) that carries sperm. The gland is the size of a walnut and is found just below the bladder, which stores urine. The prostate wraps around a tube (the urethra) that carries urine from the bladder out through the tip of the penis. During a man's orgasm (sexual climax), muscles squeeze the prostate's fluid into the urethra. Sperm, which are made in the testicles, also go into the urethra during orgasm. The milky fluid carries the sperm through the penis during orgasm.

When Should You Call a Doctor for BPH?

Urinary symptoms related to enlarging prostate initially affect the quality of life, and if no complications exist, as mentioned above (urinary infections, bladder stones, bleeding), the decision to treat is optional and is left to the patient. This means that if you don't feel bothered enough to take a medicine or undergo a procedure for it, you'll need to follow up with your doctor to ensure the symptoms are stable, and the bladder empties well. This can be assessed by prostate symptom questionnaires and a measure of the strength of the urinary stream (flow test) and residual urine in the bladder. If complications develop, however, or if the bladder starts holding increasing amounts of residual urine after urination, treatment should be started.

If you experience bladder pain or burning with urination, blood in the urine associated with fever/chills or nausea/vomiting, or if the prostate enlargement condition worsens and symptoms such as blood in the urine or lower back pain are present, consult a doctor immediately. If you cannot reach your doctor when these symptoms are present, seek evaluation at a hospital's emergency department.

For acute symptoms such as acute urinary retention (you feel uncomfortably full but cannot urinate), you should immediately go to the closest emergency medical facility for bladder drainage, usually with a catheter, which is a tube inserted into the bladder.

Men over 50 years of age should have their prostate checked annually by their physician even if they have no symptoms.

What Causes BPH?

The prostate gland, which is normally about the size and shape of a walnut, wraps around the urethra between the pubic bone and the rectum, below the bladder. In the early stage of prostate enlargement, the bladder muscle becomes thicker and forces urine through the narrowed urethra by contracting more powerfully. As a result, the bladder muscle may become more sensitive, causing a need to urinate more often and more suddenly.

The prostate grows larger due to an increase in the number of cells (hyperplasia). However, the precise reason for this increase is unknown. A variety of factors may be involved, including androgens (male hormones), estrogens, and growth factors and other cell signaling pathways (cell-to-cell communication).

As the prostate grows larger and the urethra is squeezed more tightly, the bladder might not be able to fully compensate for the problem and completely empty. In some cases, blockage from prostate enlargement may result in stagnation and backing up of urine, which in turn may cause repeated urinary tract infections, bladder stones, bladder diverticulae (outpouchings or pockets inside the bladder), and gradually result in bladder or kidney damage. It may also cause a sudden inability to urinate (acute urinary retention) -- a painful medical emergency that requires urgent drainage.

What Exams, Procedures, and Tests Diagnose BPH?

A physical exam is required to see if other medical problems may be causing your BPH symptoms. The healthcare provider will order a digital rectal exam to examine the prostate gland. The healthcare provider may feel the prostate by inserting a gloved, lubricated finger into the rectum. The rectal exam allows your doctor to roughly estimate the size and consistency of the prostate. Most importantly, it allows the doctor to feel for lumps or hard areas that could indicate the presence of prostate cancer. Your doctor may check your urine (urinalysis) for blood or signs of infection. Your blood may be tested for kidney problems (a serum creatinine level), for PSA levels (prostate specific antigen test), a screening test for enlarged prostate, prostate cancer, prostatitis, and urinary tract infections (UTIs)

Some men are referred to a specialist (urologist) for further tests. Urologists specialize in diseases of the male and female urinary tracts and of the male genital tract. Before you are treated for BPH. It is important for the doctor to rule out other possible causes of an enlarged prostate, such as prostate cancer, which is benign or non-cancerous.

Will Natural and Home Remedies Help Relieve Symptoms of BPH?

There are no natural or home remedies to treat BPH; however, you can prevent symptoms from worsening and complications. Call your doctor right away urination once you experience an urge, urinate as soon as you feel the urge, and empty the bladder completely.

What Medications Treat BPH?

Several types of medications have been approved for treatment of urinary symptoms secondary to prostate enlargement. Men with severe symptoms may require treatment with a combination of these medications. Your doctor will determine the optimal combination for your condition:

Finasteride (Proscar) or dutasteride (Avodart) can cause the prostate to shrink. As a result, the urinary symptoms may improve. These drugs are most helpful in men who have at least moderate enlargement of the prostate.

Tadalafil (Cialis for daily use) has recently been approved for the treatment of BPH.

Is Surgery an Effective Treatment for BPH?

Transurethral resection of the prostate (TURP). Transurethral resection of the prostate (TURP) is a common surgery used to treat prostate, and is considered the gold standard. In this procedure, the doctor scrapes away the innermost core of the prostate through a small instrument inserted through the urethra. The surgery reduces pressure on the urethra and generally gives relief from symptoms.

Transurethral incision of the prostate (TUIP). Transurethral incision of the prostate (TUIP) may be an option for some men. In this operation, instead of removing prostate tissue, the doctor passes an instrument through the urethra to make one or two small cuts in the prostate. These cuts reduce the prostate's pressure on the urethra, making urination easier.

Newer treatments. Newer treatments may be performed in your doctor's office with local anesthesia (you are awake for the surgery) alone or supplemented by sedation have been introduced and may be work.

Rezume therapy. Rezume therapy consists of injecting a water steam into the prostate under local anesthetic

Urolift procedure. Urolift procedure, which consists of placing small suture implants to hold the prostate tissue apart from around the urethra; transurethral microwave thermotherapy (TUMT), transurethral radiofrequency needle ablation of the prostate (TUNA), and interstitial laser coagulation (ILC). The general principle of all these treatments is similar. In each case, the prostate tissue is heated to a level that will lead to death of portions of the prostate tissue, thus shrinking away and removing some of the obstruction.

The Rezum and Urolift procedures have the advantage of preserving ejaculatory function, which can be affected by almost all other prostate procedures. These can also be done in the office without the need for anesthesia.

Photovaporization of the prostate (PVP) or laser ablation of the prostate. Photovaporization of the prostate (PVP) or laser ablation of the prostate, in which a laser is used to directly remove or vaporize prostate tissue in a similar fashion to what is accomplished with a TURP (see above) with much less bleeding. The advantage of this technique compared with TUMT, TUNA, or ILC is that it offers immediate removal of tissue with rapid improvement in symptoms. Conversely, these other three treatments lead to delayed tissue loss and are not associated with immediate improvement of urinary symptoms in most cases.

AquaBeam ablation procedure. AquaBeam ablation procedure is FDA approved in the U.S. (like the AquaBeam ablation procedure, which also preserves ejaculatory function). Ask your doctor about the potential risks and benefits of medication and surgery. An operation for an enlarged prostate does not eliminate the risk of developing prostate cancer.

Holmium laser enucleation of the prostate (HoLEP). Holmium laser enucleation of the prostate (HoLEP) is a procedure that is offered in specialized centers and allows larger prostates to be enucleated (shelled out).

Simple prostatectomy. Sometimes for very large prostates, a procedure called simple prostatectomy is indicated, which is traditionally done by open surgery. A minimally invasive procedure can be done in specialized centers where the enlarged part of the prostate (referred to as the adenoma) is removed laparoscopically or with a surgical robot through keyhole incisions instead of the open surgical incision.

What Is the Prognosis for BPH? Is it Prostate Cancer? Can it be Cured?

Your condition may improve, remain the same, or become worse. Serious urinary problems from prostate enlargement affect one in 10 older men. If the bladder is permanently damaged from prostate enlargement, treatment may not be as effective.

Prostate enlargement is not cancer, nor does it seem to increase your chances of developing prostate cancer. You can, however, have both prostate enlargement and prostate cancer at the same time.

Is It Possible to Prevent an Enlarged Prostate?

Men can reduce the need to urinate frequently during the night by not drinking liquids after 6 p.m.

Caffeinatedbeverages, alcohol, and spicy foods can be bladder irritants and make urinary symptoms worse.

Drinking more fluid, up to eight glasses of water per day, may help prevent infection. However, for men already suffering with increased urinary frequency, this may only exacerbate the problem. In most cases, drinking a normal amount of fluid based on thirst is all that is necessary.

Finasteride or dutasteride (see above) are prescription medications that can slow down the process of prostatic enlargement and reduce the risk of urinary retention, complications, and the future need for surgery related to BPH.

Health Solutions From Our Sponsors

Enlarged Prostate Symptom

Inability to Urinate

The two essential causes of urinary retention are (1) blockage of the urethra and (2) disruption of the delicate and complex system of nerves that connects the urinary tract with the brain and the nervous system (as described earlier).

Common causes

Blockage (obstruction): The most common cause of blockage of the urethra in men is enlargement of the prostate. In males, the prostate gland partially surrounds the urethra. If the prostate becomes enlarged, which is common in older men, it presses on the urethra and can block it. The most common cause of prostate enlargement is benign prostatic hypertrophy (often called BPH). Other causes of prostate enlargement include prostate cancer and prostate infection (prostatitis). Causes of blockage of the urethra that can occur in both sexes include scar tissue, injury (as in a car wreck or bad fall), blood clots, infection, tumors in the pelvic region, and stones (rare).